NEW YORK STATE
INSURANCE DEPARTMENT

TWENTY-SEVENTH AMENDMENT TO REGULATION 62
(11 NYCRR 52)

MINIMUM STANDARDS FOR THE FORM, CONTENT AND SALE OF HEALTH
INSURANCE, INCLUDING STANDARDS FOR FULL AND FAIR DISCLOSURE

 

I, NEIL D. LEVIN, Superintendent of Insurance of the State of New York, pursuant to the authority granted by the federal Social Security Act (42 U.S.C. section 1395ss) and by Sections 201, 301, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 4235, 4237 and Article 43 of the Insurance Law, do hereby promulgate the following Twenty-seventh amendment to Part 52 of Title 11 of the Official Compilation of Codes, Rules and Regulations of the State of New York (Regulation No. 62), to take effect upon publication in the State Register.

(NEW MATTER UNDERLINED; DELETED MATTER IN BRACKETS)

Subparagraph (iii) of paragraph (7) of subdivision (c) of section 52.22 is renumbered as (iv) and a new subparagraph (iii) is added to read as follows:

(iii) Each Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended (for the period provided by federal regulation) at the request of the policyholder or certificateholder if the policyholder or certificateholder is entitled to benefits under 42 U.S.C. section 426(b) and is covered under a group health plan (as defined in 42 U.S.C. section 1395(b)(1)(A)(v)). If suspension occurs and if the policyholder or certificateholder loses coverage under the group health plan, the policy or certificate shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder or certificateholder provides notice of loss of coverage within 90 days after the date of such loss and pays the premium attributable to that period, effective as of the date of termination of entitlement.

Subparagraph (v) of paragraph (5) of subdivision (d) of section 52.22 is amended to read as follows:

(v) coverage for the coinsurance amount, or in the case of hospital outpatient department services under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible.

Clauses (b) and (c) of subparagraph (ix) of paragraph (6) of subdivision (d) of section 52.22 are amended to read as follows:

(b) Any one or combination of the following preventive screening tests or preventive services, the frequency of which is considered medically appropriate:

(1)[fecal occult blood test or] digital rectal examination[, or both];

(2)[mammogram;

(3)] dipstick urinalysis for hematuria, bacteriuria and proteinauria;

[(4)] (3) pure tone (air only) hearing screening test, administered or ordered by a physician;

[(5)] (4) serum cholesterol screening (every five years);

[(6)] (5) thyroid function test; and

[(7)] (6) diabetes screening.

(c) [Influenza vaccine administered at any appropriate time during the year and tetanus] Tetanus and diphtheria booster (every 10 years).

Subdivision (a) of Section 52.63 is amended by amending the language of the cover page of the required disclosure statement to read as follows:

(COMPANY NAME)

Outline of Medicare Supplement Coverage - Cover Page:

Benefit Plan(s) _________(insert letter(s) of plan(s) being offered)

Medicare supplement insurance can be sold in only ten standard plans plus two high deductible plans. This chart shows the benefits included in each plan.

Every company must make available Plans "A" and "B". Some plans may not be available in your state.

 

 

Basic Benefits: Included in All Plans.

Hospitalization: Part A coinsurance plus coverage for 365 additional days in your lifetime after Medicare benefits end.

Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses)[.] or, in the case of hospital outpatient department services under a

prospective payment system, applicable copayments.

Blood: First three pints of blood each year.

A

B

C

D

E

F

F*

G

H

I

J

J*

Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits
    Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

Skilled Nursing

Co-Insurance

  Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible
    Part B Deductible     Part B Deductible       Part B Deductible
          Part B Excess (100%) Part B Excess (80%)   Part B Excess (100%) Part B Excess (100%)
    Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency
      At-Home Recovery     At-Home Recovery   At-Home Recovery At-Home Recovery
              Basic Drugs ($1,250 Limit) Basic Drugs ($1,250 Limit) Extended Drugs ($3,000 Limit)
        Preventive Care         Preventive Care

*Plans "F" and "J" also have an option called a high deductible Plan "F" and a high deductible Plan "J". These high deductible plans pay the same or offer the same benefits as Plans "F" and "J" after one has paid a calendar year $ deductible. Benefits from high deductible Plans "F" and "J" will not begin until out-of-pocket expenses are $ . Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include, in Plan "J", the plan’s separate prescription drug deductible or, in Plans "F" and "J", the plan’s separate foreign travel emergency deductible. (The calendar year high deductible for high deductible Plans "F" and "J" shall [be $1,500 for 1998 and 1999. Such deductible shall] be adjusted annually [thereafter] by the Secretary of the United States Department of Health and Human Services. The cover page must specify the applicable deductible amount.)

I, NEIL D. LEVIN, Superintendent of Insurance of the State of New York, do hereby certify that the foregoing Twenty-Seventh Amendment to 11 NYCRR Part 52 (Regulation 62) was duly adopted by me on this day pursuant to the authority granted by the federal Social Security Act (42 U.S.C. Section 1395ss) and by Sections 201, 301, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 4235, 4237 and Article 43 of the Insurance Law, to take effect upon publication in the State Register.

A prior notice of this regulation amendment was published in the State Register on January 3, 2001 as a Notice of Proposed Rule Making. No other publication or prior notice is required by statute.

 

__________________________________________

Neil D. Levin

Superintendent of Insurance

February, 2000